脑小血管病患者阿司匹林抵抗的发生率及其与长期预后的关系

Incidence of Aspirin Resistance and Correlation with Long-term Outcome in Patients with Cerebral Small Vessel Disease

目的探讨脑小血管病(cerebral small vessel disease,CSVD)患者阿司匹林抵抗(aspirin resistance,AR)的发生率,以及AR与结局的关系。方法前瞻性纳入2015年8月-2017年6月诊断为CSVD的住院患者。根据血栓弹力图仪测量血小板抑制率将患者分为AR组和非AR组。记录所有患者基线时人口学、实验室检查、影像学检查等资料,并在2年随访期间进行影像学复查,同时记录患者新发血管事件及死亡情况。使用多因素Logistic回归分析确定AR与结局的关系。结果共纳入94例患者,年龄为49~84岁,平均年龄66.20±7.37岁,男性55例(58.5%),AR的发生率为23.4%(22/94)。AR与2年内新发腔隙性脑梗死(OR 4.70,95%CI 1.56~24.13,P=0.041)和脑白质病变加重(OR 4.07,95%CI 1.28~11.57,P=0.038)风险相关,与新发血管事件及死亡风险无关。结论CSVD住院患者中AR发生率约1/5,AR与脑白质病变加重和新发腔隙性脑梗死风险相关。

Objective To explore the incidence of aspirin resistance(AR),and the relationship between AR and 2-year outcome in patients with cerebral small vessel disease(CSVD).Methods This prospective study enrolled consecutive patients diagnosed with CSVD in Department of Neurology from August 2015 to June 2017.The patients were divided into aspirin resistance(AR)group and non-aspirin resistance(non-AR)group according to the platelet inhibition rate measured by thromboelastography.Baseline data included demographic information,laboratory tests and imaging results.The outcomes were evaluated by recording new-onset vascular events and imaging re-examination within 2-year follow-up.Multivariate logistic regression analysis was used to determine the correlation between AR and outcome.Results A total of 94 CSVD patients were included,with the mean age of 66.20±7.37 years(range:49-84 years),and 55 males(58.5%).The total incidence of AR was 23.4%(22/94).AR was associated with the risk of new-onset lacunar infarction(OR 4.70,95%CI 1.56-24.13,P=0.041)and white matter lesions progression(OR 4.07,95%CI 1.28-11.57,P=0.038),and not associated with the risk of new-onset vascular events and mortality within 2 years.Conclusions The incidence of AR in CSVD in-hospital patients was about one fifth.AR may be associated with the risk of new-onset lacunar infarction and white matter lesions progression.